"Employment Forms Disclosure" - California

Employment Forms Disclosure is a legal document that was released by the California Department of Conservation - a government authority operating within California.

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Download "Employment Forms Disclosure" - California

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State of California Natural Resources Agency
Department of Conservation
EMPLOYMENT FORMS DISCLOSURE (GC 18720.45)
APPLICANT NAME:
POSITION APPLYING FOR:
JOB CONTROL:
1) Have you ever entered into any written agreement with a state agency in which you agreed not to seek or
accept subsequent employment with any state agency?
☐ Yes ☐ No
Directions – Must be answered by all applicants.
Government Code section 18720.45 requires applicants for state employment to disclose on their application form whether
they have entered into any agreement(s) with the state in which the applicant agreed to refrain from seeking or accepting
any subsequent employment with the state.
You must answer “yes” to this question if you have ever entered into a written agreement with any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, where one of the
terms of the agreement provided that you agreed not to seek or accept subsequent employment with any state agency. A
state agency includes any department, agency, commission, board, state employer, or other governmental unit within the
California state civil service, but does not include the California State University.
2) Have you ever entered into any written agreement with a state agency involving an adverse action, rejection on
probation, or AWOL termination, in which you agreed not to seek or accept subsequent employment with a
particular state agency?
☐ Yes ☐ No
Directions ‐ Must be answered by all applicants.
Government Code section 18720.45 requires applicants for state employment to disclose on their application form whether
they have entered into any agreement(s) with the state in which the applicant agreed to refrain from seeking or accepting
any subsequent employment with the state.
You must answer “yes” to this question if you have ever entered into a written agreement with any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, involving an adverse
action, rejection on probation, or AWOL termination where one of the terms of the agreement provided that you agreed not
to seek or accept subsequent employment with a particular state agency. A state agency includes any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, but does not include
the California State University. If you answer “Yes” to this question, please provide the name of the particular agency and the
details in the Explanations section.
State Agency:
Explanation:
I certify under penalty of perjury that the information I have entered is true and complete to the best of my knowledge. I further
understand that any false, incomplete, or incorrect statements may result in my disqualification from consideration or dismissal from
employment with the State of California.
Signature:
Date:
State of California Natural Resources Agency
Department of Conservation
EMPLOYMENT FORMS DISCLOSURE (GC 18720.45)
APPLICANT NAME:
POSITION APPLYING FOR:
JOB CONTROL:
1) Have you ever entered into any written agreement with a state agency in which you agreed not to seek or
accept subsequent employment with any state agency?
☐ Yes ☐ No
Directions – Must be answered by all applicants.
Government Code section 18720.45 requires applicants for state employment to disclose on their application form whether
they have entered into any agreement(s) with the state in which the applicant agreed to refrain from seeking or accepting
any subsequent employment with the state.
You must answer “yes” to this question if you have ever entered into a written agreement with any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, where one of the
terms of the agreement provided that you agreed not to seek or accept subsequent employment with any state agency. A
state agency includes any department, agency, commission, board, state employer, or other governmental unit within the
California state civil service, but does not include the California State University.
2) Have you ever entered into any written agreement with a state agency involving an adverse action, rejection on
probation, or AWOL termination, in which you agreed not to seek or accept subsequent employment with a
particular state agency?
☐ Yes ☐ No
Directions ‐ Must be answered by all applicants.
Government Code section 18720.45 requires applicants for state employment to disclose on their application form whether
they have entered into any agreement(s) with the state in which the applicant agreed to refrain from seeking or accepting
any subsequent employment with the state.
You must answer “yes” to this question if you have ever entered into a written agreement with any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, involving an adverse
action, rejection on probation, or AWOL termination where one of the terms of the agreement provided that you agreed not
to seek or accept subsequent employment with a particular state agency. A state agency includes any department, agency,
commission, board, state employer, or other governmental unit within the California state civil service, but does not include
the California State University. If you answer “Yes” to this question, please provide the name of the particular agency and the
details in the Explanations section.
State Agency:
Explanation:
I certify under penalty of perjury that the information I have entered is true and complete to the best of my knowledge. I further
understand that any false, incomplete, or incorrect statements may result in my disqualification from consideration or dismissal from
employment with the State of California.
Signature:
Date: